• Those who are in poverty don't have access to healthcare, which means that when they get sick they can't afford medical services to recover.
• Often, people's healthcare comes from their employer, so if the primary provider for a family is unemployed (and therefore the family is in poverty), the family doesn't have medical insurance.
• "Health Inequality" is the term used to describe unfair disparities between two demographics

•
Ambulance ride
$500-$1,000
•Fixing a broken arm
$2,523
•A regular office visit
$80
•Step on a rusty nail
$1,030
•Allergic reaction to a bee sting
$1,050
•Appendectomy
$12,000-$14,000 (depending on hospital stay)

The United States currently expends 14 percent of its gross domestic product (GDP) on health care, but that is expected to rise in the next decade.

• Indemnity Insurance o o o o
Before 1990, most health insurance was this type
Simply reimburses patients for medical expenses
Patient is free to see any doctor
The patient pays the doctor and receives back most of the cost from the insurance company.
• Health Maintenance Organizations (HMO) o o o o o
Also called managed care
Since 1990, it has dominated the market and now covers 85% of employed
Americans
Insurance companies hire doctors and hospitals to provide care for their subscribers, who pay a monthly premium and small copayments to use those services.
Costs somewhat less
Subscribers agree to go to only the doctors and hospitals the company employs and the insurer decides what medical care they will pay for.
• Medicare/Medicaid o o
National healthcare plans
Medical insurance programs for the elderly, the disabled, and the poor created by
President Lyndon B. Johnson in 1965 through an amendment to the 1935 Social
Security Act

Medicare (Title XVIII of the
Social Security Act)
• Provides health insurance for people aged 65 and over and those seriously disabled
• Covers short-term hospital and nursing home expenses, physician and outpatient services, and home health care.
• Does not cover long-term nursing home care, dental and eye care, or prescription drugs.
Beneficiaries pay a portion of the insured services.
Medicaid (Title XIX of the Social
Security Act)
• Provides insurance for certain needy individuals.
• Federal government provides partial funding but states run the program within broad guidelines.
• The states must cover hospital, physician, diagnostic, and home health services; nursing home care; and family planning for beneficiaries.
• Coverage of prescription drugs, eyeglasses, and intermediate care is optional.
• Provides money for the treatment of patients with AIDS.
• Called Medi-Cal in California

• People with disabilities and the elderly have the highest priority.
• Parents, or adults with many dependents, have priority for government healthcare when in poverty.
o o o o
In 1997, Massachusetts raised the income threshold for Medicaid eligibility for parents from 86% to 133% of poverty, and began providing premium assistance support to parents with incomes up to 200% of poverty.
In 1999, Wisconsin expanded coverage to parents with incomes up to 185% of poverty, an increase from 51%.
In 2000, New Jersey expanded coverage to parents with incomes up to 200% of poverty, up from 41%.
Also in 2000, California raised the income threshold for parents from 74% to
100% of poverty.
• Those without dependents have lower priority.
o
Massachusetts, which had previously not provided any coverage for nondisabled childless adults, began in 1997 providing premium assistance to such adults with incomes up to 200% of poverty.

1 France 2 Italy 3 San Marino 4 Andorra 5 Malta 6 Singapore 7 Spain 8 Oman 9 Austria 10 Japan 11
Norway 12 Portugal 13 Monaco 14 Greece 15 Iceland 16 Luxembourg 17 Netherlands 18 United
Kingdom 19 Ireland 20 Switzerland 21 Belgium 22 Colombia 23 Sweden 24 Cyprus 25 Germany 26
Saudi Arabia 27 United Arab Emirates 28 Israel 29 Morocco 30 Canada 31 Finland 32 Australia 33
Chile 34 Denmark 35 Dominica 36 Costa Rica 37 United States of America 38 Slovenia 39 Cuba 40 Brunei 41 New
Zealand 42 Bahrain 43 Croatia 44 Qatar 45 Kuwait 46 Barbados 47 Thailand 48 Czech Republic 49 Malaysia 50
Poland 51 Dominican Republic 52 Tunisia 53 Jamaica 54 Venezuela 55 Albania 56 Seychelles 57 Paraguay 58
South Korea 59 Senegal 60 Philippines 61 Mexico 62 Slovakia 63 Egypt 64 Kazakhstan 65 Uruguay 66 Hungary 67
Trinidad and Tobago 68 Saint Lucia 69 Belize 70 Turkey 71 Nicaragua 72 Belarus 73 Lithuania 74 Saint Vincent and the Grenadines 75 Argentina 76 Sri Lanka 77 Estonia 78 Guatemala 79 Ukraine 80 Solomon Islands 81
Algeria 82 Palau 83 Jordan 84 Mauritius 85 Grenada 86 Antigua and Barbuda 87 Libya 88 Bangladesh 89
Macedonia 90 Bosnia-Herzegovina 91 Lebanon 92 Indonesia 93 Iran 94 Bahamas 95 Panama 96 Fiji 97 Benin 98
Nauru 99 Romania 100 Saint Kitts and Nevis 101 Moldova 102 Bulgaria 103 Iraq 104 Armenia 105 Latvia 106
Yugoslavia 107 Cook Islands 108 Syria 109 Azerbaijan 110 Suriname 111 Ecuador 112 India 113 Cape Verde 114
Georgia 115 El Salvador 116 Tonga 117 Uzbekistan 118 Comoros 119 Samoa 120 Yemen 121 Niue 122 Pakistan
123 Micronesia 124 Bhutan 125 Brazil 126 Bolivia 127 Vanuatu 128 Guyana 129 Peru 130 Russia 131 Honduras
132 Burkina Faso 133 Sao Tome and Principe 134 Sudan 135 Ghana 136 Tuvalu 137 Ivory Coast 138 Haiti 139
Gabon 140 Kenya 141 Marshall Islands 142 Kiribati 143 Burundi 144 China 145 Mongolia 146 Gambia 147 Maldives
148 Papua New Guinea 149 Uganda 150 Nepal 151 Kyrgystan 152 Togo 153 Turkmenistan 154 Tajikistan 155
Zimbabwe 156 Tanzania 157 Djibouti 158 Eritrea 159 Madagascar 160 Vietnam 161 Guinea 162 Mauritania 163
Mali 164 Cameroon 165 Laos 166 Congo 167 North Korea 168 Namibia 169 Botswana 170 Niger 171 Equatorial
Guinea 172 Rwanda 173 Afghanistan 174 Cambodia 175 South Africa 176 Guinea-Bissau 177 Swaziland 178 Chad
179 Somalia 180 Ethiopia 181 Angola 182 Zambia 183 Lesotho 184 Mozambique 185 Malawi 186 Liberia 187
Nigeria 188 Democratic Republic of the Congo 189 Central African Republic 190 Myanmar

• Massachusetts has a progressive mandated healthcare plan that most would agree is a critical test for health care reform.
– Massachusetts does not fine for failure to purchase insurance.
– Massachusetts created a reformed insurance market called a connector to make affordable insurance available to all.
• More than half of the uninsured have been covered, but this was accomplished mostly with added public financing that subsidized the purchase of private insurance and expanded Medicaid.
• The state has projected that program costs may run hundreds of millions of dollars over budget.
• Massachusetts has quickly expanded coverage to the working poor, but it remains to be seen whether affordability, cost control, quality improvement, and universal coverage can be accomplished

– Government plan that can be subsidized if you can’t afford it
– Individual private healthcare

• 86% of women in the United States report having some sort of healthcare, compared to only 74% of men who have healthcare.
• In a study by the Centers for Medicare and Medicaid
Services (CMS), the greatest deficiency in care was observed for African Americans, who had a 60% greater likelihood of receiving inadequate dialysis (treatment for kidney disease) compared with whites.
• Young adults are the nation’s largest group of uninsured
— there were 13.2 million of them nationally in 2007, or
29 percent
• The American population is aging and the prevalence of chronic diseases is growing so the responsibility for prevention and the implementation of long-term care continues to shift to the individual.

• According to Urban Institute, there are 27,000 preventable deaths in America each year due to a lack of healthcare
• Uninsured people often postpone getting checked out by doctors because they know it will be too expensive, and often only seek care when it is too late. By that time, the procedures necessary are far more costly.

In 2004 the Commonwealth Fund wrote a report outlining steps to combat healthcare disparities:
• expanded access for minorities
• greater minority representation within the healthcare workforce
• consistent racial and ethnic data collection by healthcare providers

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